Shared understanding is at the heart of effective communication between physicians and nurses. It’s important in all aspects of healthcare but particularly in oncology care, where the disease and treatment regimens are complex.

Identification of the factors that lead to effective communication can help clinicians learn what behaviors they should emulate and avoid those that lead to communication breakdowns, according to a new qualitative study in Cancer Nursing.

Researchers analyzed a set of 33 video-recorded conversations that were filmed during patient care rounds in 2 oncology units in a single academic medical center; the videos, which ranged in length from 12 seconds to 17 minutes, had been filmed earlier as part of a parent study on nurse-physician communication. They looked for 4 factors that demonstrate a contribution to shared understanding: Engagement, clarification, confirmation, and resolution.

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They noted that the 4 factors occur in this sequence, starting with engagement.  They acknowledged barriers to engagement, which included nurses who didn’t speak up and physicians who notified nurses about decisions without asking for any input or feedback.

Also, they wrote, the final factor, which is resolution, might be the most important contributing factor because it leads to action being taken. They noted that in each video that reached a shared understanding there were several key events that led up to resolution:

  • The nurse repeated the care plan that they had decided on during the clarification step.
  • The nurse and physician agreed no more discussion was necessary.
  • One party offered a way to touch base if further discussion did become necessary.

“Although existing interventions to improve communication include some of the factors identified in the study (eg, closed-loop communication requires clarification and confirmation), nurses may need to pay attention to all 4 factors to develop shared understanding with physicians, to promote effective physician-nurse communication and thereby enhance cancer care,” the researchers concluded.

They also cautioned nurses to avoid indirect communication, since hinting doesn’t always lead to the desired result and may even put a patient at risk.

The study did have a few limitations, including a limited sample size, according to the researchers. The videos were filmed in 2 oncology units in a single medical center, plus the team who analyzed the videos did not include a physician and could potentially be “biased toward the nursing perspective.”


Crist K, Lafferty M, Umberfield E, Manojlovich M. Which factors promote shared understanding between physicians and nurses in inpatient oncology care settings? A qualitative exploration. Cancer Nurs. Published online May 19, 2021. doi:10.1097/NCC.0000000000000959